Low socioeconomic status may raise risk for readmission, mortality in patients with HFrEF

Low income and education level among patients hospitalized with HF with reduced ejection fraction were linked to higher risk for HF readmission and mortality, researchers reported in the Journal of the American Heart Association.

“We confirmed that both individual socioeconomic status (income and education) and neighborhood socioeconomic status were associated with poor prognosis in patients with HFrEF,” Lena Mathews, MD, MHS, medical director of cardiac rehabilitation and assistant professor of medicine at Johns Hopkins Medicine, and colleagues wrote. “Furthermore, low socioeconomic status was associated with a poor prognosis for both white and Black individuals.”

Socioeconomic status and HF outcomes

In a multicenter community-based cohort study, Mathews and colleagues evaluated 728 participants from the Atherosclerosis Risk in Communities study who were hospitalized with HF with EF of less than 50% to observe the relationship between socioeconomic status and the risk for HF readmission and all-cause mortality.

Researchers analyzed this relationship through the socioeconomic measures of education, income and area deprivation index.

The use of optimal and acceptable guideline-directed medical therapy given at discharge was also assessed to determine any differences by socioeconomic status. Researchers defined optimal guideline-directed medical therapy as prescription of at least three of beta-blockers, mineralocorticoid receptor antagonists, ACE inhibitors or angiotensin receptor blockers and acceptable guideline-directed medical therapy as at least two of those medications.

In the cohort, the mean age was 78.2 years, and 46% were women. Additionally, 34% of participants were Black.

Median follow-up time was 3.2 years, and in that time, researchers found that 58.7% of participants experienced readmission for HF and 74% died.

Both low income and low education were linked to greater risk for mortality and readmission. Participants with an income less than $12,000 had higher mortality (HR = 1.52; 95% CI, 1.14-2.04) and higher risk for readmission (HR = 1.45; 95% CI, 1.04-2.03) compared with participants with an income greater than $50,000, according to researchers.

Researchers also found that education less than the high school level was linked to elevated risk for mortality (HR = 1.27; 95% CI, 1.01-1.59) and HF readmissions (HR = 1.62; 95% CI, 1.24-2.12) compared with college/graduate school education.

Neighborhood deprivation

When evaluating the highest quartile of neighborhood deprivation, which signified the most deprived areas, researchers found it was related to risk for readmission (HR = 1.69; 95% CI, 1.11-2.58) but not mortality compared with the least deprived areas (lowest quartile).

Researchers observed a 5.5% prevalence of optimal guideline-directed medical therapy and a 54.4% prevalence of acceptable guideline-directed medical therapy but did not find significant differences by socioeconomic status.

“Prior studies together with ours suggest that clinicians and the health care system should recognize that patients with low socioeconomic status and HFrEF are at high risk for readmission and mortality,” Mathews and colleagues wrote. “Because HF readmissions impact a patient’s quality of life and are a burden to the health system, special efforts to reduce readmissions should be aimed at patients with low socioeconomic status not only at the discharge time point but also years after admission. These can include improving access to community resources, primary care and post discharge services. In addition, socioeconomic status could be routinely included in risk-assessment models for patients with HFrEF.”